Development of a Health Education Modification Program Regarding Liver Flukes and Cholangiocarcinoma in High Risk Areas of Nakhon Ratchasima Province Using Self-Efficacy and Motivation Theory

A quasi-experimental study was conducted to develop a health education modification program based on self-efficacy and motivation regarding liver flukes and cholangiocarcinoma development in Keang Sanam Nang district, Nakhon Ratchasima province, Thailand. A total of 36 individuals were invited to participate in the program and were screened for population at risk of liver fluke infection and cholangiocarcinoma using SUT-OV-001 and SUT-CCA-001. Development of health education modification program regarding liver fluke and cholangiocarcinoma prevention included 3 steps: (1) preparation, (2) health education program, and (3) follow-up and evaluation. The study was implemented for 10 weeks. Pre-and-post-test knowledge was measured with questionnaires, Kuder-Richardson-20: KR-20 = 0.718,and Cronbach’s Alpha Coefficient = 0.724 and 0.716 for percection and outcome expectation questionnaires. Paired and independent t-tests were applied for data analysis. The majority of the participants were female (55.6%), aged between ≤50 and 60 years old (36.1%), married (86.1%), education level of primary school (63.9%), agricultural occupation (80.6%), and income <4,000 Baht (44.4%). The results revealed that after the health education program, the experimental group had a mean score of knowledge, perception, and outcome expectation regarding liver fluke and cholangiocarcinoma prevention significantly higher than before participation and in the control group. In conclusion, this successful health education modification program for liver fluke and cholangiocarcinoma, therefore may useful for further work behavior modification in other epidemic areas.     

Effectiveness of a Health Educational Program Based on Self-Efficacy and Social Support for Preventing Liver Fluke Infection in Rural People of Surin Province,Thailand

Opisthorchiasis is a major problem in Thailand particularly in northeast region which also has a high incidence of cholangiocarcinomas. Since health modification is needed, this quasi-experimental study aimed to assess the effectiveness of a health education program based on self-efficacy and social support in Tha Tum district, Surin province, Thailand. A total of 70 participants were purposive selected with a history of opisthorchiasis. Participants were divided into experimental and control groups, each with 35 subjects. The experimental group received a health education program composed of: (1) knowledge improvement, lectured with multimedia, demonstration, brochure, and handbook; (2) group discussion about their health beliefs, sharing their ideas and experience; and (3) social support from village health volunteers (VHV), heads of villages (HV), friends, and members of families, and public health officer (PHO). Follow-up was by PHO/VHV/HV, with provision of certificates and flasg for household that did not eat raw fish. Data were collected by predesigned questionnaires after implementation of the program for 3 months. Comparative data was analyzed by paired simple t-test and independent t-test. The results revealed that the experimental group had mean score of knowledge higher more than before the experiment (mean difference=3.1, t=3.915, 95%CI-3.3, -1.8 p-value=0.001), and the control group (mean difference=2.5, t=4.196, 95%CI=1.4, 3.6, p-value=0.001) with statistical significance. The mean scores of practice were higher than before the experiment (mean difference=4.6, t=4.331, 95%CI-5.3, -3.1, p-value=0.001), and control group (mean difference=4.4, t=6.142, 95%CI=4.2, 7.9, p-value=0.001) . The mean scores of perceived susceptibility and perceived severity of opisthorchiasis, al well as perceived benefits and perceived barriers to prevention of opisthorchiasis, were also higher than before the experiment and in the control group (p-value <0.001). In conclusion, this was a successful health education program for liver fluke avoidance. Therefore, it may useful for further behavior modification in the other epidemic areas.     

Implementation of Health Behavior Education Concerning Liver Flukes among Village Health Volunteers in an Epidemic Area of Thailand

Background: Liver fluke infection is associated with cholangiocarcinoma; the bile duct cancer found frequently in the northeast and north of Thailand. Prevention and control particularly requires health education and behavior change. Objective: This study aimed to improve health behavior among village health volunteers (VHV) regarding liver fluke exposure in an epidemic area. Materials and Methods: A quasi-experimental study was performed during July 2015 to January 2016 in Sang Kha district of Surin province, Thailand. A total of 67 VHVs underwent a health education program (HEP) and data were collected on knowledge, attitude, and practice (KAP) before and after participation for HEP 3 months with a pre-designed questionnaire. The Students paired T-test was used for comparisons of mean KAP levels before/after the intervention. Results: The results revealed that knowledge (P-value=0.004), attitude (P-value=0.004), and practice level (P-value=0.000) were significantly improved after participation in the HBP. Attitude was significantly associated with knowledge (r=0.266, <0.05), and practice (r=0.348, <0.01) . Conclusions: The implementation of health education among VHVs is feasible and increases their KAP. This improvement should have potential in liver fluke prevention and control in local communities in rural Thailand.     

Behavioral Modification Regarding Liver Fluke and Cholangiocarcinoma with a Health Belief Model Using Integrated Learning

This study aimed to modify behavior regarding liver fluke and cholangiocarcinoma prevention in Chumphuang district, Nakhon Ratchasima province, Thailand through integrated learning. A total of 180 participants were included through purposive selection of high-risk scores on verbal screening. Participants attended the health education program which applied the health belief model included family based, knowledge station based, academic merit based and community based learning. Data were collected using a questionnaire composed of 4 parts: 1) personal information, 2) knowledge, 3) perceived susceptibility, severity, benefits, and barriers, 4) practice regarding liver fluke and cholangiocarcinoma prevention. The result revealed that the majority were female (79.9%), age ≥ 60 years old (33.2%), primary school educational level (76.1%), and agricultural occupation (70.1%). The mean scores of knowledge, perception, and practice to liver fluke and cholangiocarcinoma prevention, before participated the integrative learning were low, moderate, and low, respectively. Meanwhile, the mean score of knowledge, perceived susceptibility, severity, benefits, and barriers, and practice regarding liver fluke and cholangiocarcinoma prevention, were higher with statistical significance after participation in the integrated learning. This finding indicates that health education programs may successfully modify health behavior in the rural communities. Therefore they may useful for further work behavior modification in other epidemic areas.     

Human Papillomavirus (HPV) Health Savings as an Alternative Solution: HPV Vaccination Behavior in Adolescents

Objective: This study aimed to measure the effects of reproductive health savings (tabungan kesehatan reproduksi, Takespro) on human papillomavirus (HPV) vaccine initiation program and the quality of the decision making to get vaccinated, as measured by knowledge, attitudes, beliefs, and self-efficacy toward HPV vaccination. Methods: This quasi-experimental study was conducted on 128 students randomly allocated to intervention and control groups. This research was conducted in junior high schools. The intervention group received the health education “Takespro HPV” intervention through videos and booklets for 6 months at school. Participants in the control group received usual care from the school. Data were collected using a questionnaire of knowledge, attitudes, beliefs, and self-efficacy about HPV vaccination modified by researchers based on previous research and tested for validity and reliability. Data were analyzed using Mann–Whitney test and independent t-test. Results: A total of 40 participants were actively enrolled in the intervention group, and 88 were passively enrolled in the control group. The health education that was part of the Takespro HPV intervention improved the knowledge (p < 0.05) and self-efficacy (p < 0.05) of the intervention group compared with the control group. The attitude and belief variables showed no significant difference (p > 0.05). Forty students exhibited the health reproduction savings behavior at schools. However, the savings amount was insufficient to get HPV vaccination at the initiation phase. Conclusion: “Takespro” HPV intervention can be considered an alternative to increasing the coverage of HPV vaccination in adolescents in Yogyakarta.     

Population-Based Intervention for Liver Fluke Prevention and Control in Meuang Yang District,Nakhon Ratchasima Province,Thailand

Opisthorchiasis is still a major health problem in rural communities of Thailand. Infection is associated with cholangiocarcinoma (CCA), which is found frequently in Thailand, particularly in the northeastern. Therefore, this study aimed to evaluate the effectiveness of health intervention in the population at risk for opisthorchiasis and CCA. A quasi-experimental study was conducted in Meuang Yang district, Nakhon Ratchasima province, northeastern Thailand, between June and October 2015. Participants were completed health intervention comprising 4 stations; 1, VDO clip of moving adult worm of liver fluke; 2, poster of life cycle of liver fluke; 3, microscopy with adult and egg liver fluke; and 4, brochure with the knowledge of liver fluke containing infection, signs, symptoms, related disease, diagnosis, treatment, prevention, and control. Pre-and-post-test questionnaires were utilized to collect data from all participants. Students paired t-tests were used to analyze differences between before and after participation in the health intervention. Knowledge (mean difference=-7.48, t=-51.241, 95% CI, -7.77, -7.19, p-value =0.001), attitude (mean difference=-9.07, t=-9.818, 95% CI= 10.9, -7.24, p-value=0.001), and practice (mean difference=-2.04, t=-2.688, 95% CI=-3.55, -0.53, p-value=0.008), changed between before and after time points with statistical significance. Community rules were concluded regarding: (1) cooked cyprinoid fish consumption; (2) stop under cooked cyprinoid fish by household cooker; (3) cooked food consumption; (4) hygienic defecation; (5) corrected knowledge campaign close to each household; (6) organizing a village food safety club; (7) and annual health check including stool examination featuring monitoring by village health volunteers and local public health officers. The results indicates that the present health intervention program was effective and easy to understand, with low cost and taking only a short time. Therefore, this program may useful for further work at community and provincial levels for liver fluke prevention and control.     

Community-Based Health Education and Communication Model Development for Opisthorchiasis Prevention in a High Risk Area,Khon Kaen Province,Thailand

Background: This study aimed to evaluate the impact of a community-based health education and communication programme on reducing liver fluke infections caused by the consumption of uncooked fish among people in a high-risk area of Thailand. Materials and Methods: The study was quasi-experimental in nature, with three-stages. Stage 1 involved a situational and capacity analysis of designated communities in Khon Kaen province. This was followed by the development of a model for community-based health education and communication to prevent liver fluke infections among high-risk people, and, lastly, implementation and evaluation of the model were performed. Data were collected using both qualitative and quantitative methods. In total, 390 people were surveyed, and quasi-experimental and comparison groups, each with 90 people, were assessed between May 2011 and April 2012. Analysis was using statistical OR, 95 % CI, the Willcoxon matched pairs signed ranks test, the chi-square test, and the Mann-Whitney U test. Results: The findings showed that most respondents had a high level of knowledge and understanding of liver fluke disease (89.5%, 95% CI:86.0-92.4), and positive attitudes toward the prevention of the disease (94.4%, 95% CI:91.6-96.4). However, with regard to changes in consumption of uncooked fish, most respondents were still in the pre-contemplation phase (55.1%, 95% CI:50.0-60.1), followed by the contemplation phase, 22.6%. Furthermore, four factors were found to be associated with the consumption of uncooked fish - the consumption of alcohol (OR 4.16, 95% CI:1.79-9.65), gender (OR 3.17 , 95% CI:1.53-6.54), smoking (OR 3.03, 95% CI:1.31-7.05), and age 40 years and above (OR 2.68, 95% CI:1.02-7.05). After nine months of the health education and communication programme using local media based on local wisdom, culture and persons, the results showed that, compared to the control group, members of the experimental group had a higher level of knowledge, a better attitude and lower levels of illadvised consumption behaviour. Also, it was found that consumption of uncooked fish, by an assessment of the level of stage of change, was reduced. (p-value 0.002). Conclusions: The health education and communication programme developed as part of the study was effective in changing the consumption of uncooked fish. Therefore, this approach should be promoted in other high-risk areas in Thailand in the future.     

OVCCA Web Application as Supplementary Material to Facilitate Health Literacy Regarding Carcinogenic Human Liver Fluke: A Randomized Controlled Trial in Thailand

Background: Liver fluke, Opisthorchis viverrini, is associated to cholangiocarcinoma which is found frequently in some areas of Southeast Asian countries particularly in Thailand, Lao People Republic Democratic, Cambodia.  This study sought to investigate the effects of an O. viverrini and cholangiocarcinoma (OVCCA) web application to facilitate health literacy regarding O. viverrini in Northeast Thailand. Methods: A randomized controlled trial study was performed among an intervention group (n=63) and a control group (n=63) during a one-year period from July 2019 to May 2020. The intervention group received the health literacy promotion program of O. viverrini information through the OVCCA web application for 6 weeks. The control group received an activity package from the public health department. The success of the program was evaluated at week 24 after the groups finished the last activity. ANCOVA, t-test and multiple logistic regression were used for data analysis for both groups. Results: The scores for knowledge; ability to access, understand, appraise, and apply information; motivation for protection; and practice of O. viverrini prevention were significantly higher for the intervention group than for the control group. The results indicated that a health literacy promotion program through an OVCCA web application could be advantageous for preventing and controlling O. viverrini infection. Conclusion: This intervention may be used as a potential strategy and guideline for self-care and health promotion in other endemic areas.     

Knowledge of Female Undergraduate Students on Breast Cancer and Breast Self-examination in Klang Valley,Malaysia

Background: In Malaysia, breast cancer is the first cancer among females regardness of race. Aim: The purposeof this study was to identify the knowledge and BSE practice among undergraduate female students at fourpublic universities in Klang Valley, Malaysia. Materials and Methods: This cross-sectional study was conductedamong 820 undergraduate female students using a self-administered questionnaire covering socio-demographicdata, knowledge of breast cancer and BSE practice. Results: The mean age of the respondents was 21.7±1.2years. The majority of them were single (96.8%), Malay (91.9%) and 16.5% of respondents had a family historyof breast cancer. This study showed low level of knowledge on breast cancer and breast self-examination amongparticipants. Only 19.6% participants were performing BSE regularly. Knowledge of breast self-examination wassignificantly associated with BSE practice (p=0.00). Also, there were significant associations between performingBSE with age, marital status and being trained by a doctor for doing BSE (p<0.05). Conclusions: Our findingsshowed that the rate of BSE practice and knowledge of breast cancer is inadequate among young Malaysianfemales. A public health education program is essential to improve breast cancer prevention among this group.     

Effects of Breast Self-Examination Consultation Based on the Health Belief Model on Knowledge and Performance of Iranian Women Aged Over 40 Years

Background Breast cancer is the most prevalent malignancy in women worldwide; lack of awareness of symptoms and delay on diagnosis of breast cancer are the main causes of mortality among women. This study was conducted with the purpose of assessing the effect of educational consulting for breast self-examination (BSE) based on the health belief model (HBM) on the knowledge and performance of women over 40 years attending health care centers in Hamadan, Iran. Materials and Methods In this quasi-experimental study, eligible women admitted to health centers in Hamadan city in 2015 were randomly assigned to intervention and control groups (n75 in each group). The intervention group received 4 weekly sessions of breast cancer screening consulting based on the HBM. Control group received only routine care. Knowledge, HBM constructs, and BSE practice were compared between the groups before, immediately after and three months after the consultation. Results Before the intervention, no significant differences were observed in knowledge, health belief and practice between two groups. However, after the intervention a significant difference was observed between two groups in mean scores of perceived benefits, perceived barriers, self-efficacy and the health motivations (<0.05). Significant differences were also observed in terms of knowledge and BSE practice (<.01). Conclusions The results indicate the importance of consultation on knowledge and beliefs to improve BSE performance and prevention of breast cancer in Iranian women.     

同质健康教育模式对结直肠癌造口术后患者自我护理能力、自我效能及心理弹性的影响

目的探讨同质健康教育模式对结直肠癌造口术患者自我护理能力、自我效能及心理弹性的影响。方法采用随机数字表法将行造口术治疗的100例结直肠癌患者分为改进组(给予同质健康教育模式干预)和对照组(给予常规健康指导),各50例。比较两组患者干预前及干预4周后的自我护理能力、自我效能感及心理弹性。结果干预4周后,改进组患者自我护理测定量表中自护概念的认知、自护责任、自护技能、相关知识了解维度的评分及总分均高于对照组患者,差异均有统计学意义(P﹤0.05)。干预4周后,改进组患者的自我效能感评分明显高于对照组患者,差异有统计学意义(P﹤0.01)。干预4周后,改进组患者由Connor和Davidson编制的心理弹性量表(CD-RISC)中坚韧、自强、乐观维度的评分及总分均高于对照组,差异均有统计学意义(P﹤0.05)。结论同质健康教育模式对结直肠癌造口术患者的自我护理能力、自我效能感及心理弹性具有明显的改善作用。     

健康思维导图式健康教育在乳腺癌根治术后患者中的应用效果

目的 探讨健康思维导图式健康教育在乳腺癌根治术后中的应用效果.方法 采用随机数字表法将80例乳腺癌根治术后患者随机分为试验组(术后给予健康思维导图式健康教育)和对照组(术后给予常规术后康复指导),各40例.比较两组患者的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、自我效能感和肩关节功能.结果 术后2个月,试...     

The Role of Health Volunteers in Training Women Regarding Coping Strategies Using Self-Efficacy Theory: Barriers and Challenges Faced by Health Volunteers in Empowerment of Women

Introduction: Psychological distress is among physical and mental health threats, and health volunteers can play a critical role in empowerment of women. However, evidence has revealed a decline in health volunteers’ activities. Therefore, the present study aimed to investigate the challenges faced by health volunteers in empowerment of women. Methods: The participants’ knowledge level was assessed using a written test. Their perceived skills were also measured using Coping Inventory for Stressful Situations by Endler and Parker and Chesney’s Coping Self-efficacy Scale, respectively. The study data were entered into the SPSS statistical software, version 11.5 and were analyzed using chi-square, sample t-test, and Pearson’s correlation coefficient. Results: The results showed a considerable increase in the intervention group health volunteers’ knowledge about stress, as well as their self-efficacy. Besides, a significant correlation was observed between self-efficacy and task-oriented strategy scores. However, no significant increase was found in this group’s coping strategies. The results also indicated a significant increase in the intervention group women’s knowledge about stress, but no significant change was observed in other constructs. Some challenging factors, such as managerial, personal, and interpersonal factors, were also detected that might have affected the results. Discussion: This study caused no considerable change in coping with stress, except for increasing the women’s knowledge in this regard. Considering the challenges identified in this study, programs should be developed for researchers and health center managers to improve this condition in future.